Cutaneous and subcutaneous complications of calcium infusions

Five infants with hypocalcemia experienced complications after treatment with calcium gluconate intravenously. Inadvertent soft tissue extravasation resulted in erythema, subcutaneous calcification, tissue necrosis, skin slough, and transient radial nerve damage with wrist drop, the latter previously unreported. The soft tissue lesions may be mistaken for cellulitis, abscess, calcified hematoma, or osteomyelitis, resulting in unnecessary antibiotic therapy or surgical intervention. Initially, no clinical abnormality may be apparent. The lesions appear from days to weeks following extravasation. Radiographs are initially negative but soft calcification appears in one to three weeks. Follow-up x-ray films show complete resorption of the calcium over several months. Skin sloughs heal in four to six weeks without skin grafting. Extreme care in the parenteral use of calcium gluconate and conservative treatment of the complications is advocated.